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tv   Blue Cross Blue Shield CEO Scott Serota at Detroit Economic Club  CSPAN  October 10, 2019 6:04pm-6:53pm EDT

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>> cspan2 camping 2020 coverage continues as president trump houses keep america great valley in minneapolis, minnesota. like tonight at 8:00 p.m. eastern. on cspan2 watch anytime on and listen wherever you know using the freight cspan2 radio app. >> the head of blue cross blue shield says millennials are the sickest generation the insurance company is study. president annie celia scott told members of the detroit economic club that illness among millennials is due mainly to mental health issues. he also talked about the future of healthcare. prescription doug cross and innovation.
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>> thank you steve. good afternoon everybody. welcome to our dc members and or guests. it is wonderful to be here at the detroit economic club. organization is long attracted some of the nation his most distinguished thinkers and innovators. it is my privilege to introduce today's participants. we'll engage us to the capitated rating discussion about the future of healthcare. the may begin by introducing our guest speakers, someone who i've known for monday years and consider him a mentor and a friend. scott promises the president and ceo of the blue cross blue shield association national federation the source 36 independent community-based and locally operated blue cross blue shield companies. including blue cross blue shield of michigan. the blue cross blue shield system through his federation of insurers, covers one out of every three americans. i think this is the very important statistic.
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what else does this frankly. it serves every zip code in the united states. in every zip code in america, someone has a blue cross card. it's overseeing one of the most trusted brands in healthcare. for the nation his most influential leaders in our field driving public policy and conversations on healthcare and healthcare reform. everyone has access to quality affordable healthcare. scott has devoted his career to include health to all americans through innovations like the bc bs health index and health of america reports. it identifies health issues and challenges and provides insight to improve the quality of care across america. scott was named president and ceo of the csa in 2000 after surfing four years a senior executive vice president including two years as chief
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operating officer. prior to that, and executive vice president, for system development, he was in charge of new business strategy and bc bs technology evaluation center. he is renowned for evaluating safety and effectiveness of emerging medical treatments. when you're in scott's tenure, the required program was introduced through this national program, which allows blue pan members who receive health benefits of traveling or living in another part of the blue area. our nationwide membership in the system, has increased from $65 million from the beginning to hundred and 6 million members today. scott was at the home of monday of the important policy debates. it includes limitation of the affordable care act. it was his vision to use available data to develop insight about what is happening in the health across america. in driving solutions on healthcare trends like millennial health.
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before he joined, he served as president ceo of chicago-based financial rush health plan. he also created and led positions for prohealth preferred healthy misery based be a joke. scott is the leader of an association with strong commitment to corporate responsibility. he's also driven to be cynically active both professionally and personally. in addition to surfing on numerous blue cross boards. his founding member of the national business group on health institute of healthcare costs solutions a board member of the brain research foundation and advisory board member of paragon biosciences. he also serves in the leadership council to healthcare financial management association. the american college of healthcare executives, the dean's leadership council and purdue university and the washington university school of medicine national council. scott is also advised the white house and congress on policies
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programs and services affecting our older citizens and was a charter member of the american health information community. the commission to advance health information technology. he also serves the ceo advisory board building a healthier chicago. scott earned a bachelors degree from purdue university where he is the proud boilermaker and holds a masters in health administration planning the washington university school of medicine. it also holds an honorary doctorate of science degree from purdue. i also like to introduce moderate today, doctor deanna live. an award winning health reporter ww j news radio 950. previously deanna was a medical report of her major tv news stations. miami chicago and boston. she is reserved multiple awards for reporting including six emmy award nominations. michigan association of broadcasters award and to american heart association
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awards. deanna holds a bachelor of science degree in nutrition from michigan state university and earned a doctorate of interactive medicine from doctor william school college of podiatric medicine in chicago. she completed her surgical residency in the phoenix community hospital. it is my pleasure to introduce both scott and deanna. let's give them a warm welcome and were looking forward to their comment conversations. [applause] >> hi and good afternoon. i am thrilled to be here with the detroit economic club and thank you for having me. and scott i want to officially welcome you. >> thank you.
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>> were going to be talking about the mission for the future of healthcare. a lot of people that i talked to over the past few weeks, found out that i was going to be meeting with you today, they all had some questions that i should ask you. one question kept showing up over and over again let's start with this. i'm sure it's something you've never heard. they want to know why is healthcare so expensive for consumers and businesses in our country. >> that's an easy question. i get the question but didn't get a lot of applause we do said that i'm a proud boilermaker. i have to go on record, my daughter didn't see the live and she is the proud spartan. [applause] yet to do something
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to get the audience on your side. okay why is healthcare so excessive. healthcare is unique in that the consumer of services is typically the person anchor the service. you got a strange dynamic in that environment. you have organizations both of it is the government or are insurers like the blues who are paying for the service but our manufacturing plant if you will, on physicians the hospitals and the others who are delivering the service. lots of disconnects and lots of missing checks and balances. so that would be .1. i think the, we got the healthcare system on a piece basis. that is, the more you and the more you get paid.
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so we have created human sedatives in the system for delivering excessive care so long as it care it's not going to do any harm. so we have a scenario where providers are incentive to deliver more care, patients have no offer to except the care clause are typically not paying for it. and payers are after-the-fact trying to manage the care and remote bases. that drives price up and second, what is more important than health. nothing. so we invest as a society i believe appropriately, lots of dollars in creating innovation. an inviting new pharmaceutical breakthroughs new ways in which to drive better value in the system, i hope the zone alarm of some kind. to drive better value in the system and those innovations in those breakthroughs have a price
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attached from them with also increased live expectancy and health outcomes and eradicated diseases that we have done a lot of good things with those dollars. the next evolution, the logical question though is what can we make it more affordable. the evolution there is to move our healthcare system to one that is less focused on inputs and more focused on value. to begin to construct relationships between payers and providers that are focused on the outcomes of the care that are received rather than the inputs. in fact, the michigan plan here, blue cross blue shield of michigan is one of the leaders in that movement about 5000 physicians operate here on the patient centered medical home. an environment where the primary care physician begins to manage or take ownership of the full spectrum of care of the people who are part of his or her
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practice. we try to do that across the country and then in fact, our system alone, 70 million americans get their care through some forum of a value -based care arrangement. the goal there is to focus our reimbursement on improving the outcomes that our patients received. ensuring results. we have had diminished readmissions to the hospital and diminish emergency room utilization increased compliance with chronic disease treatments and protocols. we have a whole host of activities that are beginning to show positive results. long made it through to a short question. >> a lot of insurance companies and businesses offer wellness programs and incentives so if you quit smoking or you lose weight, i just wondered how effective are these. are they worth businesses
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investing in. >> i believe that any investment you make in your employee, enforces health is the benefit. i think improving lifestyle having people lose weight, reducing smoking, and those of things all have positive outcomes in the jury still out on both of the investment in those programs is actually paying out in real dollars benefit. but i think in if you factor in the noneconomic or the non- hard economic factors like reduced sick days and productivity measures, he's clearly an investment we should all be making and worth making. >> suggested for about a year from now, we're going to be having a big election and healthcare is always the big issue. if you know running or you were advising a candidate.
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>> the former will never happen. [laughter] >> let's say you were advising someone, what are some things that would make a good health plan and what are some things as voters we should be looking for. >> i'm a big believer in building on what works. and not just tearing things up for the fink of tearing things up. where i advised any of the candidates, i would say we spent destination, a long time working on and debating and implementing the affordable care act. i would build on its successes. i would look at the fact that as of this moment, in excess of 90 percent of americans have health insurance today. so i would look at ways that had we close that gap to get the last 10 percent i think the number i saw this morning was
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seven and a off percent. how to close that gap to get those folks that went out disrupting the care that the rest are receiving area so there are a number of public policy initiatives that we could do. i would improve lower costs and improve our ability to access care in that regard. i would encourage candidates to look at the issue of pharmaceutical costs and promote the idea, not just in pharmacy but the entire healthcare system of transparency. allowing patients and, employers and insurers to have real line of sight understanding of what the components of healthcare really caused and how therefore identify where the opportunities are for improvement. how are varmint drugs priced. let's get some transparency into what other costs and
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developmental clause the real cost, the research costs. how are the spices developed so we can have a better public policy discussion about how much we as a society can afford to spend on that regard. we have to develop a public policy initiatives on my constructs. we now have our first drug that exceeds $2 million. for treatment. we have to as a country, figure out how to deal with those particular issues. we have to improve access and lots of communities, we have to ensure our rural hospital survive. there is no shortage of an agenda isn't the made it through to your question in this regard but i think is the priority, i would say focus on building on what's working today as opposed to distrusting what is working today just for the fink of destruction. >> so there've been some major health issues in the news
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lately. i kind of wanted to get your take on them. were talking about the future of healthcare and also how does a blues combat these things. for example, vaping e-cigarett e-cigarettes, here we have five people that died over 450 have been hospitalized with respiratory illness. we do do something that is newer and you don't have a lot of data on. >> the issue of how to deal with vaping, can put it in a broader category. how do you deal with lifestyle issues. how do we as a society we as a blues, as dan said earlier, we are in every community. what makes us unique, the unique qualifications of our programs are our people live in the
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communities in which they operate. so when we make decisions and policies, when we decide what our priority issues, it's impacting our neighbors. and her friends. it is our families is in our community so we are very community activities committed to them. i put all of these things be a smoking, baking mating, nutritional issues, all of these things into a category of social determinants of health. visible system, feel committed to take the resources and the insights and information that we have, and trying to work with local communities to solve those problems. we want to be certain that people his genetic code is more important than their zip code as we look at how we attack healthcare issues. try to take the data and information we have worked with
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policyholders carmakers, in washington and state capitals. so they can understand the depth of the problem. and so they can understand the communities that are infected with the problems and we try to work with this communities to actually take our resources and our steps to invest in those communities to solve those problems. his vaping today is opioids yesterday. unfortunately voip is for a long time. vaccination rates. the best way to deal with this is with facts and data and information and we try to bring to the communities. were blessed with the data resource clause of a hundred and 7 billion members in every zip code in every edge and every demographic, we are blessed with the data resource that provides us great insight into that so the trick is to take that insight and provided back to the people who can really make a difference.
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t-mac when we think of healthcare a lot of times we think that the elderly are the sickest. but a saybrook class report with the millennials are not the healthiest group. can you talk a little bit about that. >> waiver program called the health of the american. we've done 27 different kinds of reports. on various health and additions. in this beautiful stadium, one of the ones that get the headlines early on was our customer report that was the ideas. on the front page of the estate today and a whole host of others. the latest one we did was on millennial health. i will tell you we were very surprised that we found that the millennial generation, which will be 50 percent of the workforce in 2020, at this stage of live, the sickest generation
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of any other cohort group and it relates. six of the 10 percent of the ten top ten conditions are mental health or emotional health related conditions. generally stemming from detachment issues loss of virtual contact but not enough human contact were seeing chronic conditions arise like high blood pressure high cholesterol things of that nature and that generation that we would fully expect to see in people 20 or 25 years older than them. it is an issue of quite a pit and importance to us. we with the blues have taken that on is kind of a mission of ours. to try to address this issue. listening sessions. the data only tells you so much so we went out and spoke to
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spoke to the millennials and asked them what they are looking for speaking. >> interesting late, people might generation, seniors unfortunately, are very concerned about privacy. not an issue for the millennials. what they want is the compassionate medical professional who is wheeling to treat them as a whole person and look at their conditions in a comprehensive in the context of their live as opposed to treating each disease and condition independently. kind of like the patients in our medical homes that your doing here in michigan. they're very free to share information. those six horses anywhere to try to seek solutions to the problems. but they are really craving human contact. in the ability to interact and communicate with people.
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eleven cities in november we are having a national combination of pit in philadelphia where we are bringing leading people and experts in millennial health together we can begin to embark on a campaign to try to address these issues clause i know about you but i'm counting on those millennials to support the healthcare system in the future to take care of me. we need to be sure that that generation is as healthy as they can be. and they should be. given their physical edge. >> do most even a primary care physician. >> no i would say that the number of millennials with a primary care physician, is markedly lower in seniors. they prayed that. and they're looking for that connection so i think that maybe one of our short-term solutions
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is trying to help make those connections. they're much more comfortable with virtual care than we would be. much more comfortable with telehealth programs in other generations. so we have to find the sweet spot where we can get them connected to the healthcare system. >> what about artificial intelligence in the future of healthcare. >> artificial intelligence and machine learning, i think have a wonderful opportunity to do a number of things. first in underserved countries, around the world. artificial intelligence can surf as an extension into a lot of streaming that might otherwise not get done or clause of the lack of access to medical professionals, i was at a conference recently where some executives from google, some google oars in the room here, we're talking about working with
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artificial intelligence and machine learning to do retinal scanning in india which is grossly underserved from an ophthalmologist standpoint. and they found that the scanning in the screening that they did compared to a few months writing was actually better. in the preliminary screenings. if you multiply those kinds of activities, and various areas you can envision a time when we can get trained radiologists and pathologists and others, my words out of the baseman into the bedside, and have a lot of the screening work done by machines and have the medical trained medical professionals overeat actually get more involved in the more complex matters leaving the routine matters to machines. i think there's a wonderful opportunity for us to be more efficient and more effective in the delivery and care and free up our medical professionals to
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deal with much more complex problems. i think it has a an incredibly bright future. >> , as we are moving, we have more electronic records, patient portals and we are using wearable devices for medical testing. what about our security of their health information. t-mac couple of comments on that. one of the greatest challenges in my professional live has been more frustrations, the lack of interoperability of healthcare data. in ability for us to share data between hospitals and physicians in between our devices and our physicians electronic medical, take-or-pay, who had very little success in spite of enormous investments. her dan mentioned that as part of the very first health information community.
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it's not one of the stellar successes of my professional live. we were charged by the bush administration to try to find and create a national inoperable standard and still working on it. making safe we've created those kinds of standards. we are not there in healthcare and we need to be. so in a proper oval ability for the challenge for the next administration and virtually probably will be for the generation after that and after that. we have to create these data superhighways that we can continue move information seamlessly amongst and between people so we can have a better understanding of health conditions that people have building off of an individual record. notes from privacy and security, there's a lot of us secure concern and fear about that. in any location, people at least our generation, not necessarily the millennials, they are very
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protective of that data and the identity theft is clearly easier if you have access to all of this kind of information. unfortunately the bad guys are usually a subhead of the good guys in the fight but we invest in the blue system and enormous amounts of money trying to ensure protection of health data with established national standards we've adopted national standards established by others to protect that kind of health information to others do the same as just a never ending battle but that we have to fight. to ensure that that data is protected as much as it can be. >> what about precision less medicine in the future of healthcare. >> precision medicine. for those of you unfamiliar with the term is really developing interventions that are focused on your own personal genetic code. it is understanding your genome
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and your genetic makeup and then targeting treatments to you specifically. obviously, extremely expensive. but has the potential to be curative. i think that we are just beginning to see the potential of that. it means now is the time to establish national policies about how to deal with that. how to protect that precious data. this necessary to develop those targets. how to pay for it. clause it's going to be astronomically expensive. but again if it's curative, and a substitution for other treatments, may not necessarily have to be added to the total cost of healthcare. we have to have a national debate. which i have a solution, don't. it is something that we as a society need wrestle with now before it becomes so ambiguous
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that it's treating all kinds of conditions. >> we have all of this information, we offer a lot, how do we get patients to take some responsibility for their healthcare. clause we have obesity epidemics human childhood obesity is authorized. >> if i had the made it through that question, but personal accountability is the cornerstone of any successful health policy. someone argue you have to have skin in the game. you need to be paying some of the premium, you need to understand the economic applications of the decisions that you make. some others would argue that the implications are not and don't always need to be economic. the health applications themselves should be sufficient deterrent. but watch generation after generation smoke and eat
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unhealthy and not exercise. so the health applications are an insufficient motivator. i think we have to create healthcare system which has accountability and consequences. the difficulty is, do you really create those consequences and how do you make them relevant. if the health conditions themselves are not consequences enough, what can you do to create a consequence. the thing starts with education. i think it starts with education at the preschool loophole. and you begin to educate the children the families, the communities about the importance of health. but you do it in a fashion that not only education about what they need to be doing that facilitates them doing it. and that again expected the social told determination of
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health and that they have access to everything they need. in our world, and the blue cross blue shield world, we view this and take this very seriously. created blue cross blue shield institute was focuses on social determinants of health. the first area we we started with was transportation. clause we found the number of people were noncompliant with vacations or appointments clause they just couldn't get there. so we partner with lifton over so that when physicians make appointments, for the patients they can also asked them to have a ride. if not, we can arrange for transportation to and from. we can arrange for the cars to take them to the pharmacy and actually get their medications. yes really recognize monday communities don't have access to healthy feuds. we've created a program we call a feud q which will deliver all
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the meals. a very low cost to communities that have deficiencies in access to fresh fruits and vegetables and things. clause we are in every community and we have patients in every zip code, this matters to us everywhere. we're trying to develop programs that are portable, repeatable and they can live with the skill of those times of programs. our next efforts are fitness. will begin to look at areas where there is insufficient either places to exercise or programs. begin to invest back. opportunities, are going to get better. it's one thing to tell people to do it and it's another thing to show them a path. we want to be able to do both. >> we only have a few seconds left, is your vision for the future of healthcare.
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positive ? >> i'm extremely bullish on the future of our healthcare and industry. personal, who could be more important than health. i know we wring our hands about what percent gdp is going to health and all of those kinds of things. it's hard for me to think of something that is more important than that. so investing in health i think is appropriate so long as you are getting outcomes. and value for that investment so i'm very bullish on that. it's an huge employer in the market place and were very committed. i'm also polish but there are opportunities to make dramatic savings in the cost of healthcare today just the financing of healthcare by building on the successes of the affordable care act and by investing at the national loophole perhaps in catastrophic
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insurance. where sickest people would be covered by catastrophic policy. that the government would be responsible for the rest of us would operate underneath that. we could reduce premiums by a third and a program like that and improve outcomes. so there's wonderful opportunities for us to make great improvements both in the delivery and financing of healthcare. great time to be of healthcare professional. jack i thank you so much. >> thanks deanna and scott. now it's my pleasure to ask some questions to the audience. we'll start off scott, the aca, how would you rate it. and what is coming. >> when started i'd probably given it a c. it had a kind of rocky roll-up. systems and network etc.
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i think over time, we've all committed to improving it. all healthcare professionals government alike. i think it's approaching two b a b+ and i think it has an upward trajectory. i think that if congress acts in a responsible fashion and bills on the successes, some of things i talked about with regard to shoring up the idea of a reassurance program and investing in making sure that the subsidies are appropriately administered for a relatively modest investment, we could have a dramatically positive impact remember statistic, somewhere between seven have been 10 percent of people are insured. that means 90 to 93 percent are currently covered. in the affordable care act has played a role in that making that happen. >> the student questionnaire. i think blue cross blue shield in healthcare industry as a
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whole, will advanced and change over the next five to ten years. >> first, i will be retired. it will be someone else's vision that you will be discussing. from the blues perspective, i think yes he is investing much more in technology. much more in our ability to use data to predict outcomes and assist providers in intervening early in the treatment of care. you see a greater movement towards value -based contracting. 70 million of our members are connected through a value -based today. i would assume it would be all of our members within the next five or so years virtually every relationship we develop will be focused on outcomes and successes as opposed to inputs. so by the way to go.
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i think the healthcare industry will be much more rapid to adapt technology. we will eventually within the timeframe, solve the interoperability problems so we can share and communicate information. any much more transparent, will have a much deeper understanding of pricing structures and outcomes. patients will be able to shop for healthcare like they shop for televisions and cars and things. you be able to do comparison shopping. will be best-performing institutions. it would be an exciting time for the industry. >> piggyback on that. and technology continues. we are clearly replacing the old with the new but the problem is unlocking innovation is hard. what are your thoughts sort of about that a novation and of all of this and how we can make breakthroughs easier than we have.
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>> the issue in healthcare today it's not necessarily the breakthroughs, is the adoption of them in rapid. large piece of the economy as we are today, healthcare, and attracts a lot of money and a lot of entrepreneurs. so there's a lot of very smart people trying to solve some really complex problems. we've seen some incredible things and things unfulfilled. i think that healthcare innovation will be sparked by patient demand by a movement towards a much more patient focused and patient centered delivery system. and we look at our healthcare system from the patient out,
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historically we've looked at it from from the professionals and, as we start looking as the patient out we are going to find that there are credible opportunities for us to improve communication and education and information and unlock the power of entrepreneurship into the healthcare system. once we do that, i think we'll find wider spread adoption. >> in the current medicare for all act and similar bills in congress and if they were to pass, when impact would that have on blue cross organization and what role could or would medicare advantage play in all of this. >> medicare furl takes monday shapes and means monday things to monday people. as you can well imagine i think
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the destruction that would be caused, by medicare for all program makes it unfeasible to implement and not in the best interest of our nation. i think that american people are used to choice is important that the healthcare system of the future is the public-private partnership edge play a very important role in sparking innovations and creativity and managing costs. on the tighter partnership between the government and the private sector is necessary and better communications. and sharing of information and data. building on the success of the affordable care act. i think all of our critical pieces, self defined medicare for all as literally met a car or all. every american is automatically enrolled in medicare program. that environment so upset, animate private insurers.
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if you take that extreme pleasure, obviously medicare is the you become a service reimburse her for everybody. and the more traditional if there is such a thing, and the less progressive implementation would be a medicare -like program. a single day care program. and there would be robust competition amongst the fastest growing program today. medicare medicare advantage. it's a program that the government reimburses private insurance. we can be by establishing creative innovative new mechanisms new benefits, and were evaluated on our performance on the star system getting reimbursed based on our successes and how well we treat patients and how well they evaluate us. the michigan plan is one of the nation his leaders in medicare advantage.
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it was spectacular job on doing that and embracing that particular program. but it will be a vital piece of the medicare for all. it would allow the private sector to continue to compete for patients in that environment the advantage programs would be reimbursed by the government, the government would pay medicare advantage programs, who in turn would contract and pay and incentivize providers. so could be a personal link just as it is today in the existing medicare programs. >> before we get to the lightning round, pharmaceutical cost. is there an made it through and it's almost on a daily basis the uc stories and the politics of washington around parma. where is this going and is there a solution. >> there must be a solution clause we cannot afford the current trajectory of the
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pharmacy benefits. i think that the made it through lies in a couple of things. transparency lies and understanding the pricing formulas and then lies in injecting some new competitors into the market place i think all of those are coming. i would say stay tuned for some very very exciting announcements with injecting new competitors into the marketplace. now are moving to the lightning round. >> quick question a quick made it through. >> i don't really do quick answers but i will try. >> put something in your bucket list. >> a hole-in-one. [laughter] >> what is your favorite teen growing up. >> it was and is the chicago bears. >> so if i asked you in october 27th, bears or lions, a few months with the question. >> yes. was less bulky read.
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>> spy novel. i don't have a lot of time to read so want to do a try to read something that catches my attention. the mitch rapids, the star of this book, things fall red zone, sort of the ci eight. business adventures is in my briefcase. it's an old book, only archive articles about successes and failures in the business community that i've been meaning to read back i read one story every now and then. as a best book. if you get brownie points for carrying it, i've had it my briefcase for about six months. the godfathers of favorite movie. >> favorite vacation spot.
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>> jackson hole wyoming. >> what is advice you give yourself is the 25 -year-old. >> lineup. i took live is it too seriously when i was young. >> best for when you are going up. >> his football. >> what person other than a family member would like to have lunch with. >> that's a really good question. i would said while and partially cite here anymore. >> final question. you've been here monday times. describe detroit in the order two. >> i'm not pandering here but amazing, and resurgent. the downtown until the story
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before, ten years ago 12 years ago you been there 14 yourself only 18 years ago we need came here i stated the das 18 years ago and i wanted to get some food and they said will bring it to you. don't leave. today, you go to the dse, you can walk around and you can go to restaurants, it is a remarkable resurgent. it is truly an american success story. should all be preparing part of the community. it is but amazing. contact thank you. >> one quick announcement before we say thank you and adjourned. if you like today's program and you want to hear it again, you can download the audio podcast tomorrow about this time. in fact we're just recently named as one of the top podcast in metro detroit.
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budget up in your phone and listen again. how about another round of applause for scott deanna and dan. [applause] evolved an amazing job. thank you for being with us. scott particularly you, thank you so much for giving us your thought leadership. ladies and gentlemen thank you for coming today on time every time in this meeting is now adjourned. thank you. [applause]. [background sounds] weeknights this week we are featuring quick tv program showcasing every weekend on c-span two tonight street, harvard professor and white looks at how work propaganda was disseminated in the united states. la weiss recalls the women suffers movement leading them to the ratification of the 19th amendment. riley talks about the nazi censorship efforts in the
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1930s. to repress artistic works, question i be gaining an eight seat eastern posse spent two and enjoy but to be this week and every weekend on c-span. here's diversity and issue on federal courts. advocacy lawyers and the dean of howard university law school take on that question. the center for american progress posted this discussion on how diversity impacts litigants. legal decisions and the justice system. >> good morning everyone i'm the executive vice president of external affairs for the center of american progress. among thank each and every one of you for joining this very important if it. on d

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